Current Approaches to Cervical-Cancer Screening

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.A 72-year-old woman has had an annual Papanicolaou (Pap) smear with normal findings (Figure 1) for the past 30 years. She finds it difficult to undergo pelvic examinations because she has severe arthritis in her hips and vaginal atrophy. She has not been sexually active since the death of her husband 10 years earlier, and she wants to know whether she can stop being screened for cervical neoplasia.The Clinical ProblemAlthough screening for cervical cancer with the Pap smear is one of the most effective preventive interventions that clinicians can provide in their offices, concern about the accuracy . . .